Sclerotherapy - Spider Veins Treatment

 

Questions and Answers

 

What are spider veins?

Veins are blood vessels that return blood to the heart.  There are tiny veins that drain the skin.  They are usually so small that they are hard to see. When they get too big, they become unsightly and these are called spider veins. They are small red or purple veins just below the surface of the skin. Usually they are flat, but sometimes you can feel them. 

These red/purple veins are fed by greenish blue veins that are larger and a bit deeper (just below the skin). These are called reticular veins. Because they feed spider veins, they need to be treated at the same time as the spiders.

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Why do spider veins develop?

There are two reasons that the tiny veins of the skin get bigger and become a cosmetic concern:
1) hormones
2) back-pressure.

Hormones: the vast majority (about 80%) of spider veins are caused by female hormones. Puberty, birth control pills, and pregnancy all increase the formation of spider veins. But even the normal levels of hormones in the female body are enough to trigger spider veins. These types of spider veins are seen in predictable patterns (outer thigh, outside below the knee, and inside above and below the knee). Men rarely get spider veins, because their hormones are different.

Back-pressure: varicose veins are larger veins in which blood flows downwards into the leg (instead of upwards to the heart). The pressure inside these veins is transferred to tiny veins in the skin creating spider veins.  These pressure-type veins can be found anywhere on the legs. Anyone (men and women) can get these pressure-type spider veins.

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How do I get rid of these veins?

The best treatment for spider veins of the legs is sclerotherapy. Multiple injections are done into the red/purple spider veins and into the green/blue reticular veins that feed them.

In some cases, varicose veins feed the spiders, and these need to be treated first. Sometimes these varicose veins are not visible. We search for them by listening with a Doppler or looking with ultrasound. About 20% of the patients who come to us thinking they only have spider veins actually have hidden underlying varicose veins.

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What is sclerotherapy?

Sclerotherapy is a technique for the elimination of veins that involves the injection of various fluids directly into veins. This causes an injury to the lining of the vein. The vein dies, and your body then breaks it down.*

This technique has been in common use since the late 1940’s. There is also evidence that Hippocrates used it over two thousand years ago! It has stood the test of time because it is safe and because it works.*

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What kinds of veins can be treated?

Any vein large enough for the insertion of a needle can be treated. This includes huge varicose veins down to tiny “spider” veins (correctly called telangiectasias). 

This page covers the treatment of spider veins of the legs. For large veins, see the Varicose Vein Treatment page. For facial vein and rosacea treatments, see the Facial Vein Treatment page.

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What substances are injected?

Red and purple spider veins are treated using Sclerodex. This is a mixture of sugar and salt.

The larger green/blue reticular veins are treated with a synthetic soap called Tromboject. This is diluted to varying degrees to treat different-sized veins. (This is the same substance we use to treat large varicose veins where it is used in its most concentrated form and converted to foam. It is diluted and used in liquid form when treating small veins.) 

There are several other substances that are in common use, but for various reasons, we don’t use them in our clinic for the treatment of small veins. These include salicylic acid (Aspirin), iodine, saline, and glycerin.

The most common of these is probably saline. Many people have heard of this or have actually been treated with it. We don’t use it because it stings and it is very prone to causing skin injury (ulceration and scarring).

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What about using lasers to treat spider veins?

Lasers can be quite effective in the treatment of red/purple spider veins. However, they are not as good at treating the green/blue reticular veins. Since these veins feed the spiders, failing to adequately treat them leads to treatment failures or rapid return of the spiders.

In addition, since the flow in leg veins is going uphill back to the heart these veins have relatively high pressure in them. This also decreases the efficacy of lasers.

Generally lasers hurt more, cost more, and don’t work as well as sclerotherapy.

The only people for whom we will consider using lasers are those with a powerful aversion to needles.

The big exception is facial veins. Laser is the treatment of choice for facial veins and rosacea. It works well in this area because these veins generally have no reticular veins feeding them, and they are low-pressure veins draining downhill to the heart.

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How much does sclerotherapy hurt?

Pain perception varies greatly from person to person, so this is hard to answer. The vast majority of people do just fine. 

The red/purple spider veins are very close to the surface. There aren’t many nerve endings at this level in the skin. Some of the injections will not be felt at all. 

The green/blue reticular veins are deeper and the needle will encounter nerve endings going this deep. These injections will be felt as needle pricks. 

A very fine needle is used (27G and 30G) so it isn’t that bad.

The substances we use are generally not felt as they are injected (unlike other substances like saline and iodine which sting and burn).

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Don’t I need these veins?

No you don’t. There are plenty of healthy veins that drain the skin. These other veins are more than enough to accomplish the task.

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What are the risks of leaving these spider veins?

Spider veins have only cosmetic significance. Occasionally they can be symptomatic (burning, pinching, itching), but otherwise, they have no medical significance. They will not progress to varicose veins (although they may be the only sign that you have deep varicose veins that you can't see or feel). There is no risk in leaving them untreated.

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How many treatments will be required?

There is no simple answer to this. It depends on the extent of the vein problem. 

Most people will need two to six sessions. A few will need only one session,  and a few people need more than six sessions.

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How long do treatments take?

About 25 minutes.

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How long between treatment sessions?

Spider vein treatments are usually spaced at four-week intervals. After a vein is injected it will look the same or even worse for a few weeks until your body breaks down the injured tissue. If we bring you back too soon, we’ll end up trying to treat injured veins that still look like spider veins. If we space treatments a month apart, any spider that is still visible at that time is an active spider vein that needs to be treated.

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What should I do to prepare for treatment?

Do not shave your legs the day of treatment. Tiny nicks in the skin will sting when we use antiseptic. 

Do not apply lotion or cream to your legs. We apply cotton balls to the injection sites and the tape will not stick.

Bring a pair of loose shorts. Bring long pants or a long skirt to wear afterwards.

Bring support hose to wear after treatment. In most cases, we will measure you at the time of your consultation and have the hose ready for you at your first treatment.

Eat well before you come to avoid hypoglycemia and fainting.

Drink lots of fluids before your treatment to fill up your veins and to prevent fainting.

Avoid exercise (even walking) prior to treatment. This may drain your veins and make injections more difficult. It is preferable to stand for a prolonged time to fill your veins.

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What can I expect following treatment?

Following treatment of spider veins you should go for a brisk walk. Support hose is recommended for a few days to reduce complications like bruising and pigmentation. 

There is no such thing as too much exercise following sclerotherapy. You are encouraged to be as active as possible, except in the first 24 hours when vigorous exercise should be avoided.

For a few days you should avoid hot baths, saunas, hot tubs, etc.

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What are the risks of sclerotherapy?

Sclerotherapy is an extremely safe technique. Serious complications are rare.

Bruising around the injection sites is normal following sclerotherapy. These bruises resolve within ten days. 

Increased pigmentation along the course of the vein is fairly common. This may take a few weeks to resolve.

Allergic reactions can occur to the injected agents. The risk is so small that no one can put a number to it. Severe allergic reactions carry a risk of one in millions. 

Extremely rarely, blood clots can form away from the site of injection in the deep vessels of the legs. Clots in this area may break loose and travel to the lungs. This can be fatal. This risk is so small it is hard to put a number on it (one in millions).

(Let's put the last two items into perspective. The risk of being struck by lightning is about 1 in 10 million. Your annual risk of dying in a car crash is 1 in 6,500. And that's about the same as your risk of dying in an accident in your own home [1 in 7,000].)

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Does OHIP cover the cost of sclerotherapy?

The treatment of spider veins is not covered by OHIP.

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Does extended health insurance cover the cost of sclerotherapy?

In most cases the answer is no. Check with your insurer. Receipts will be provided. Sometimes, insurance companies will cover the cost of the medication, but not the cost of the treatment itself. Likewise, insurance companies may cover the cost of prescription support hose.

Sclerotherapy is eligible for claims to your Health Spending Account because the service is provided by a physician.

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Is sclerotherapy eligible for tax credits?

Probably not. Although a physician provides the service, Revenue Canada cracked down on the use of tax credits for cosmetic procedures starting in 2010. Check with your accountant.

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What is your cancellation policy?

We require 48 hours notice for cancellations.  If this is not received, you may be billed $100.

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*Results may vary.

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